DIME Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine Fellowship Director, Medical Education Research, University of Ottawa, Ottawa, Ontario, Canada.
Med Educ. 2024 Jan;58(1):27-35. doi: 10.1111/medu.15179. Epub 2023 Aug 9.
Electronic health records (EHRs) have transformed clinical practice. They are not simply replacements for paper records but integrated systems with the potential to improve patient safety and quality of care. Training physicians in the use of EHR is a highly complex intervention that occurs in a dynamic socio-technical health system. Training in this complex space is considered a wicked problem and would benefit from different analytic approaches to the traditional linear causal relationship analysis. Social Sciences theories see technological change in relation to complex social and institutional processes and provide a useful starting point.
Our aim, therefore, is to introduce the medical education scholar to a selection of theoretical approaches from the Social Studies of Science and Technology (SSST) literatures, to inform educational efforts in training for EHR use.
We suggest a body of theories and frameworks that can expand the epistemological repertoire of medical education scholarship to respond to this wicked problem. Drawing from our work on EHR implementation, we discuss current limitations in framing training for EHRs use as a research problem in medical education. We then present a selection of alternative theories.
Unified Theory of Acceptance and Use of Technology (UTAUT) explains the individual adoption of new technologies in the workplace and has four key constructs: performance/effort expectancy, social influence and facilitating conditions. Social Practice Theory (SPT), rather than focusing on individuals or institutions, starts with the activity or practice. The socio-technical model (STM) is a comprehensive theory that offers a multidimensional framework for studying the innovation and application of EHRs. Practical examples are provided.
We argue that education for effective utilisation of EHRs requires moving beyond the epistemological monism often present in the field. New theoretical lenses can illuminate the complexity of research to identify the best practices for educating and training physicians.
电子健康记录（EHR）改变了临床实践。它们不仅仅是纸质记录的替代品，而是具有提高患者安全性和护理质量潜力的集成系统。培训医生使用 EHR 是一项高度复杂的干预措施，发生在动态的社会技术医疗系统中。在这个复杂的领域进行培训被认为是一个棘手的问题，需要采用不同于传统线性因果关系分析的分析方法。社会科学理论将技术变革与复杂的社会和制度过程联系起来，为我们提供了一个有用的起点。
因此，我们的目的是向医学教育学者介绍来自科学技术社会研究（SSST）文献的一系列理论方法，以促进 EHR 使用培训方面的教育工作。
我们提出了一系列理论和框架，可以扩展医学教育学术的认识论范围，以应对这个棘手的问题。我们从 EHR 实施工作中汲取经验，讨论了当前在医学教育中框架培训 EHR 使用作为研究问题的局限性。然后，我们提出了一系列替代理论。
接受和使用技术的统一理论（UTAUT）解释了新的技术在工作场所中的个体采用，其包含四个关键构念：绩效/努力预期、社会影响和便利条件。社会实践理论（SPT）不是关注个人或机构，而是从活动或实践开始。社会技术模型（STM）是一个全面的理论，提供了一个多维框架来研究 EHR 的创新和应用。提供了实际的例子。
我们认为，要实现有效利用 EHR 的教育，就需要超越该领域中经常存在的认识论一元论。新的理论视角可以阐明研究的复杂性，以确定教育和培训医生的最佳实践。
